Individual
RONALD J BLACKHURST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7001 S 900 E STE 450, MIDVALE, UT 84047-6016
(801) 561-5212
(801) 561-5239
Mailing address
7001 S 900 E STE 450, MIDVALE, UT 84047-6016
(801) 561-5212
(801) 561-5239
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
136235
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136235
STATE LICENSE
UT
Enumeration date
02/07/2007
Last updated
07/08/2007
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